Medical & Hospital Scandals

Features Health - January 9th, 1998

Staying healthy in Japan

by Elyse Rogers

Those living in Japan these last few months could hardly have missed the media cov­erage regarding the Yasuda Hospital and the scandals with the Osaka hospitals in the Yasuda group. The hospitals’ top managers, including Director Mototaka Yasuda, have been formally accused of fraud. Authorities believe the hospital was billing the local government for in­surance payments based on nursing staff figures that were artificially inflated. Everyone has been a loser in this scandal—estimated to involve as much as ¥2.5 billion. Certainly the patients were losers, not getting the care they needed, and the govern­ment (therefore the taxpayers) are losers because money that was designated for medical care went into private coffers.

Obviously Japan is not alone with such problems. Greed is a common failing with mankind around the world and medicine is, unfortunately, a way to satisfy that greed in some cases. In America we have the scandal involving the Columbia HCA Healthcare Corporation which is being investigated for possi­bly obtaining fraudulent Medicare payments. In some cases, the payments under investigation were for treatments not actually given, and in other cases for more expensive or extensive treatments than were provided. Not a pretty picture.

The U.S. situation is particularly sad because it is a blow to “for profit hospitals” which many hoped vould provide a way to deliver better care at less cost “to the patient or to the third-party payers.

Lack of faith

So what does that mean for all of us? That medicine is as crooked or corrupt as some other entities? That we must always be worried and be wary—even when something as important as our health is concerned? Is no one person, profession or institution to be trusted?

The answer to all those questions could be a cyni­cal, depressing answer; if one is looking for perfec­tion in a world run by imperfect human beings. Sure, there are physicians or hospital administra­tors who are “bad apples” just as there are some accountants or contractors who are unethical or even dishonest. But I don’t think that comes as a surprise to most mature adults. But it can be scary, particu­larly when you personally, or one of your loved ones, is ill and looking for competent, compassionate diag­nosis and treatment. Add to that the inability of most of us to judge professional competency, and when tag on one more problem for us expats in Ja­pan—the challenge of a cultural and language barrier in obtaining medical care.

Losing faith in a medical profession or in the sys­tem itself is an understandable reaction, I guess, but I think it’s self-defeating. Much as we’d all like a perfect world, it just isn’t going to happen. Wishing for it, or condemning everyone with the same broad brush (or suing wildly as we are apt to do in the U.S.) doesn’t help much. In fact, as with most types of anger and resentment, the person who is the real loser is usually the one who harbors the anger rather than the one who is the target.

What can you do?

Does that mean we just throw up our hands, say shikata ga nai and take whatever comes our way? No, I don’t think that’s a wise course either. There are certainly some steps all of us can take to im­prove (notice I didn’t say “guarantee”) our chances of getting the best possible medical care for ourselves and those we love.

  1. Go to a doctor or other medical professional who has an established reputation in the commu­nity or is affiliated with an institution with a good reputation. This may take a bit of homework, but it’s well worth that effort. A recommendation from a neighbor or friend can be helpful, but take the source into account when you evaluate the recommendation. If your friend is a flake or hypochondriac, you may want to look beyond that single recommendation for the professional you choose.
  2. Make sure the doctor or other professional is a good fit for you. If you want someone who carefully explains treatment options and gives you choices, be sure that’s the type of professional you sign on with. We preach nowadays that the “best” type of medical care is participatory care, in which patient and doctor work together for the same goal, which is the ultimate health (both physical and mental) of the patient. And I think that makes a lot of sense, since we are usually more motivated when we are involved in the deci­sion-making process. But everyone is different and if you are content to have the “sensei make the deci­sions,” then pick the more autocratic type of profes­sional. Since that is the usual type in Japan (due both to the educational system for physicians and the na­tional health insurance system that promotes very short patient visits), you shouldn’t have a problem finding the “do as I tell you” doctor or care giver.
  3. Don’t try to practice medicine. This may seem contrary to what I said before about participating in your own care, but it’s not. Being a partner with a medical professional is fine; deciding what kinds of medicine you need or engaging in self-diagnosis can be not so fine. For example, there is a serious problem today of antibiotic-resistant bacteria (a problem which is growing) because antibiotics have been overused and abused. Viral infections such as colds do not respond to antibiotic therapy, although some doctors con­tinue to prescribe them, and many patients con­tinue to demand them. Also, a too-short course of antibiotic therapy can cause bacteria to become resistant—in other words, stopping the drug when the symptoms disappear and not when the bacteria has been totally annihilated.
  4. Practice healthy living. Experts tell us that many of today’s major diseases are preventable or postponable. (Far better to get heart disease at age 80 than at age 40.) Lung cancer can be largely prevented by not smoking; many cancers are less prevalent in those who eat good diets (low in fat, high in vegetables and fruits) and adhere to a lifelong exercise program; and a myriad of diseases (such as some forms of diabetes and heart disease) can be thwarted by not becoming obese. Of course, it’s true that there are some people who violate every rule of good health and live long, disease-free lives, and conversely there are those who do “everything right” and die young. But the latter are the exceptions rather than the rule, and in the case of health, it’s far better to go with the averages.
  5. Stay away from the doctor. With excellent medi­cal care here in Japan and the U.S. and in many other countries, you certainly should avail yourself of proper medical care and treatment in the event of a serious illness. But running to the doctor with every sniffle or every simple ache or pain is foolish and can actually be harmful. Remember that medical care is set up to treat disease, so give your physician a chance to do what he/she does best, and not swamp the system with minor ailments. Many serious diseases start with what in medical terms is called “general malaise.” In every-day language, that means “feeling lousy” the way we all do with the flu, minor food poisoning, being over-tired or over­indulging in food or drink. But one should hardly suggest that we get a battery of tests, take major drugs or be hospitalized for these minor illnesses. So, use common sense in deciding when to see or call the doctor. (Please note: I’m not saying that every mi­nor illness should be ignored; every illness must be evaluated based on the individual situation. And, of course, people with a history of serious illness or those who have chronic illnesses are a whole different ball game.)

Although the media keep us well informed about the abuses in the medical systems around the world, there are many dedicated medical professionals in every country ready and willing to serve. Try your best to find one of these, live as healthy a life style as you can— and relax. “Having a good attitude” is touted today as an important part of healthy living. At the very least, a good attitude makes life a lot more fun and far more pleasant for those around us. The “nothing to fear but feat itself” adage is as true about our physical well-being as it was in the brutal times of war.